KINE 639 - Dr.

Green Section 6

The Athletes Heart & ECG

Reading in Conover: pages 253-271

The Athletes Heart & ECG

Common abnormalities seen in an athlete
Sinus bradycardia (up to 91%) may be less than 50 beats / minute
reflects predominance of vagul tone may exhibit junctional escape rhythm Sinus arrhythmia 1st and 2nd (type I) degree AV block (10% - 33%) Left ventricular hypertrophy (up to 76%) Incomplete RBBB (up to 51%) QRS width between .10 and .12 seconds Early repolarization mild J-point and ST segment elevation differential diagnosis Brugada Syndrome elevated J-point swoops into a negative T-wave Premature atrial & ventricular contractions

The Athletes Heart & ECG

38 year old male distance runner with sinus bradycardia (42 bpm) with periods of junctional rhythm (red arrows)

The Athletes Heart & ECG

41 year old male distance runner with J-point and ST-segment elevation (arrows) depicting early repolarization

The Athletes Heart & ECG Patholigical LVH

LVH in an athlete
Note strain pattern in lateral precordial leads

The Athletes Heart & ECG

Early repolarization pattern of Brugada Syndrome (elevated ST-segment goes into a negative T-wave in V1 and V2) Early repolarization pattern of an athlete (note voltage criteria for LVH is borderline)

Brugada Syndrome predisposes one to Ventricular Tachycardia / Ventricular Fibrillation.

The Athletes Heart & ECG

Causes of Sudden Death in athletes Long QT syndrome QT interval longer than .44 seconds
Predisposition to Torsades de Pointes, a type of V-tach
Hank Gathers died in 1990 while playing basketball (went off meds) Hypertrophic Cardiomyopathy of the Left Ventricle Symptoms: chest pain, dyspnea, syncope Predisposition to V-Tach Arrhythmogenic Cardiomyopathy of the Right Ventricle Familial condition where RV myocardium is replace by fibro-fatty tissue

Predisposition to V-tach
Congenital Coronary Artery Anomalies Pete Maravich had no left coronary artery died of MI at 40 years of age

The Athletes Heart & ECG

Long QT syndrome

Torsades de Pointes associated with long QT syndrome (a deadly type of Ventricular Tachycardia)